Provider Demographics
NPI:1528257037
Name:LOPEZ OSA, DIEGO RAMON (MD)
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:RAMON
Last Name:LOPEZ OSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 BOLIVAR ST
Mailing Address - Street 2:SUITE 639
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1349
Mailing Address - Country:US
Mailing Address - Phone:504-568-4864
Mailing Address - Fax:
Practice Address - Street 1:533 BOLIVAR ST
Practice Address - Street 2:SUITE 639
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1349
Practice Address - Country:US
Practice Address - Phone:504-568-4864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-21
Last Update Date:2007-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1239097Medicaid